Oncological Outcomes and Organ Preservation After Brachytherapy for Penile Carcinoma: A Multicentric Retrospective Study by the Brachytherapy Group of the French Society for Radiation Oncology

Abstract

Purpose: Penile cancer is a rare malignancy with significant implications for patients' quality of life due to the sensitivity of the affected organ. Although partial or total penectomy remains the standard treatment, its functional and psychological sequelae are significant. Brachytherapy is an effective alternative to penectomy offering penile preservation and good local control. This multicenter retrospective study aims to evaluate the oncological outcomes and organ preservation after brachytherapy for localized penile carcinoma.

Methods and materials: This study included patients with localized penile carcinoma (T1-T3, N0-N2, and M0) treated across 4 French Cancer Centers. Patients underwent interstitial brachytherapy using low-dose rate, pulse-dose rate, or high-dose rate techniques. Clinical and pathologic data were collected, and survival outcomes were analyzed using Kaplan-Meier methods. Toxicities were assessed per National Cancer Institute Common Terminology Criteria for Adverse Events v4.0.

Results: The charts for 408 patients with localized penile cancer, treated with interstitial brachytherapy between 1970 and 2020, were reviewed retrospectively. At a median follow-up of 76 months, the 5-year local control, penile preservation, and overall survival rates were 86% (95% CI, 82.5-90), 85% (95% CI, 81-89), and 82% (95% CI, 78-87), respectively. Acute grade ≥2 toxicities occurred in 34.3%, whereas late urethral stenosis was observed in 18.1%. Circumcision history was associated with a lower risk of acute grade ≥2 toxicities, with odds ratio of 0.115 (95% CI, 0.035-0.376; P < .001). Lymph node involvement emerged as the most significant prognostic factor for disease progression and metastases.

Conclusions: This study, the largest to date, confirms the efficacy and safety of brachytherapy as a penis-preserving treatment for localized penile carcinoma. It highlights the importance of lymph node management and multidisciplinary approach, while underlining the need for standardization of protocols to optimize results and limit complications.